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Business Clinic
Wellbeing Teams: Making self-managing homecare a reality

Helen Sanderson, a long-time driver for person-centred social care has developed self-managing homecare through Wellbeing Teams. Is this what is needed to reform homecare?

Established in 2015, Wellbeing Teams was set up by Helen Sanderson and based on the Buurtzorg model of self-managing ‘neighbourhood teams’ in the Netherlands. CMM covered Buurtzorg in Business Clinic in 2015.

Helen explained why she started Wellbeing Teams, ‘Over 20 years as a trainer and consultant, I have been immersed in a world of person-centred practices, one-page profiles, personalised care and support planning, personalisation, person-centred reviews and Working Together for Change. I feel like I have made offers of different ways of working, and helped to show what these could look like in practice.

‘In setting up Wellbeing Teams, I want to demonstrate what these practices can actually look like in teams supporting people living at home.’

What are Wellbeing Teams?

Wellbeing Teams are small, neighbourhood, self-managed teams. Comprising no more than a few people, teams work locally to be flexible and responsive to an individual’s needs, focusing on people’s outcomes and building up support networks.

With homecare workers under increasing pressure, Helen identified a need to change the way services were delivered for the benefit of the people using the service and those delivering it. Helen continued, ‘The challenge was to create a different way of delivering support for people at home that is truly person-centred, where they have choice and control, and it’s delivered by an engaged, happy workforce. Having choice and control matters to our Wellbeing Workers as well as people using services, and having friends at work is critical to productivity and happiness. That is why we build choice, control and relationships into the DNA of Wellbeing Teams.’

The structure of the teams means it removes certain layers of management, reduces costs and keeps decision-making close to the individual. Wellbeing Workers are fully trained on self-management processes and have a team coach and buddy system. Teams are supported to use their judgement whilst also undertaking their core responsibilities.

Helen explained, ‘Each team has a coach to support them, and a buddy. The team meets every week to share information, address any issues and support each other. The team shares the roles needed, and they choose their roles based on their strengths. They then develop their rota/schedule together after the meeting.’

Wellbeing Teams have six core values: compassion, responsibility, collaboration, curiosity, creativity and flourishing. Helen explained, ‘Central to this is the context in which the teams operate and most importantly, the headline purpose of the team is to support and connect people with their community.

‘Teams are built on the following: Relationships are everything; Wellbeing; Person-centred support; Bringing our whole selves to work; Appreciation and feedback; Taking risks and learning; Celebrating; Trust; and Openly sharing information.’

Helen added, ‘Aligning values and practice is a key step in enabling a coherent and stable team culture to evolve.’

Supporting people

The Wellbeing Teams work closely with the people they support, use person-centred thinking tools and one-page profiles to learn what matters to each person and share this information. Helen continued, ‘People choose what they want support with (their outcomes and priorities), how they want to be supported, when and where. We enable them to choose their team too, either through looking at the team’s one-page profiles or a three-minute film of a team member introducing themselves.’

This enables the teams to deliver outcomes and not tasks, working flexibly and proactively to achieve the individual’s wishes. Teams focus on self-care, assistive technology, family, friends and wider circles of support to link the individual with their local community, to support them to be active in their local area, reduce the risk of isolation and delay the need for paid support. Being very local, the team is familiar with its local community and able to make connections. Once these avenues have been explored, Wellbeing Workers are able to deliver any outstanding, unmet support needs.

Offering solutions

Wellbeing Teams work with commissioners and other care and support providers to deliver the model. They are currently working with Wigan Council and moving forward with Thurrock Council, Trafford Council and Oxfordshire County Council in the coming months. Helen added, ‘By the Autumn, we should have 11 teams up and running, across five local authorities.’ They are also working with providers, Care Unbound and Making Space.

Helen continued, ‘We want to expand and scale in a measured way. We are introducing Trusted Assessors into our teams, and expanding how we use technology as well as building on community assets. We also want to support people in different situations and with different needs. We are already supporting people with learning disabilities, and would love to support more individuals and families.

‘We are in discussions with a national charity about teams to support people with long-term conditions, and with a GP surgery to show what a Wellbeing Team based within a GP’s surgery could look like. We are looking at teams that will have health colleagues in as well, and we have just recruited our first occupational therapist.’

Wellbeing Teams are looking to offer the wider system solutions to help people get home and stay at home. This work can be undertaken in partnership with Community Circles, which brings teams together around the individual.

Helen finished, ‘Our vision for the future and offer to commissioners includes working as part of multi-disciplinary teams in home from hospital support; with GP practices; as part of a Virtual Ward; and as part of a hospice at home team.’

Over to the experts…

What are your thoughts on Wellbeing Teams and the self-managing model? Can it be an integral part of the health and social care system? Does it have the potential to become the standard approach to working?

The difference in self-worth and prestige is key…

Papworth Trust, in its current overview of disability in the UK, reports that nearly one in eight older people now live with some level of unmet need with vital everyday tasks. These are just some of the people who would likely benefit from appropriate care and support in their own homes. But local authority-funded homecare has been particularly badly hit from cuts to adult social care budgets, leading to high-profile cases of larger providers handing back contracts or exiting the sector.

Lack of funding also contributes to the lack of prestige for care workers, as noted in the recent National Audit Office report on the adult social care workforce. Not only does this impinge on recruitment and retention; it also feeds a lazy stereotype that the care sector doesn’t care.

It seems to me that it’s the difference in self-worth and prestige that is key here, even more than the reduction in costs from lower overheads. This is what makes self-managing teams, such as Helen’s Wellbeing Teams, such a potential game-changer for the sector.

The combined effect of coaching – really about continuous improvement – buddying, choosing a role based on your strengths and commitment to person-centred support, makes it impossible not to recognise the skills and expertise of the people involved. This, in turn, is what makes a conversation about parity of funding possible.

The big question is how to spread the approach across the 9,100 homecare providers and 527,000 staff in the UK, so that we don’t create a two-tier system. But the knowledge and the willingness of local authorities to try new approaches is out there. Every homecare provider should be thinking about this.

Debbie Sorkin National Director of Systems Leadership, The Leadership Centre 

An innovative approach to care and support

In our work on asset-based places, we argue that we need to shift funding away from high cost, often low quality, reactive care provision. We need to move towards more preventative and empowering care and support which builds on people’s strengths and networks. An asset-based approach ultimately places the emphasis on people’s and communities’ assets, alongside their needs.

We think that the Wellbeing Teams offer an innovative approach to providing care and support which does exactly this. In places like Thurrock, Wellbeing Teams are being developed as part of an ambitious plan to provide an asset-based area which harnesses the passion, interest and strengths of people and communities. These areas are seen as the way forward.

We published a blog from Les Billingham, Head of Adult Services at Thurrock Council, in which he explores Thurrock’s whole system re-design of health and wellbeing services. He says it is predicated on strengths-based principles and the importance of co-production in all aspects of community development and service transformation. He says partnership sits at the heart of this endeavour along with a willingness to learn from a whole range of pre-existing approaches from around the world.

Helen and Wellbeing Teams are right to be thinking hard about how they bring this model to scale. However, for it to work it will require commissioners to commission differently by shifting resources towards prevention. Alongside this, it will also require Wellbeing Teams to clearly demonstrate their impact.

Showing that they can work as part of multi-disciplinary teams is also the right way forward, and we will soon be producing a guide on this.

Ewan King Director of Business Development and Delivery, SCIE 

I really welcome Helen’s innovation

Helen came to speak at our NCF Managers Conference last year about Wellbeing Teams and the way in which she was approaching some of the key challenges of delivering homecare in the UK.

Her message was warmly received because it really addresses two challenges very close to the heart of all who work in care. Namely – how, in an increasingly austere market, do you deliver truly person-centred care and sustain an engaged, value-driven workforce?

Many commentators have been very interested in the Buurtzorg model which Helen refers to, and one of the key attractions has been the evidence produced from Holland of how self-managing nursing teams have stripped away centralised control and overheads.

I am interested in how Helen has approached this, through embracing technology in both attracting staff and in delivering care. In particular, the very strong drive to enable technology to push and sustain family and community connections, with the care creating the right environment and support to enable people to retain or regain as much independence as possible.

Here, I think is the really clever element. The much-championed self-management element of the Buurtzorg model has been adopted and adapted, so that it applies both to the workforce and the person receiving services. It gives staff the flexibility to develop relationships which means there is a real opportunity for the care delivered to be meaningfully structured and shaped around people and their community.

I welcome Helen’s innovation, and I am particularly pleased to see a handful of commissioning authorities recognise the power of new models and new thinking.

Vic Rayner Executive Director, National Care Forum 

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